On March, social networks were filled with photos of unpaired socks to celebrate World Down Syndrome Day and as enunciated the slogan that accompanied the campaign: “Raise awareness of the difference and bet on inclusion.” A few days ago, the colored socks again flooded our screens, this time with the hashtag #CrazySocks4Docs, aiming to draw attention to the problem of mental health in medical professionals, remembering those who have died (by suicide) and push towards a change in the “culture of health” maintained till now. Both campaigns point out to us that we are afraid of “what is not expected”, and the only way to confront it is to look face to face, accepting that we are all “differents”.

Just one year ago, the Australian cardiologist Geoffrey Toogood invented the hashtag #CrazySocks4Docs to fight the stigma of mental health among the medical profession, after suffering personally a depressive process. This stigma does not affect only physicians, it is common to the entire health population and society in general. One in four people will suffer a mental health problem throughout their lives. It is utopian to think that health professionals are immunized in the face of this statistic: the working conditions, the silence of a misunderstood corporatism, the stigma, the ease of access to psychodrugs… make this problem particularly important and of serious consequences for the affected person and the environment.

It is not casual to use the adjective “crazy” to refer to those socks symbol of the unpaired, the different, the unexpected… We are afraid of vulnerability and that which we do not see clearly or do not control. Mental health problems are an “invisible enemy” that we cannot photograph with a diagnostic test; they are difficult to limit in their definition, symptomatology and intensity. We have trouble transmitting and explaining to others and they are full of prejudices and topics (even among health workers). We are afraid of mental illness and that fear we can only face if we work on mental health, as a continuum where personal and professional life shake hands, where genetics and features merges with the learned and every single life history , where not only the symptoms are seen but the psyche that underlies: where we look at the PERSON.

Recently, in  Intensive Care Medicine, in the Correspondence section, Laurent et al. describe as a “bubble” the studies of prevalence of professional wear (burnout) in critical care professionals, because they estimate that there is an inadequate use of the MBI questionnaire as a “diagnostic tool”, and propose “not to speculate with the prevalence of burnout” and instead focus the diagnosis on depressive disorders. The authors have reason to point out that MBI is not a diagnostic instrument: it is an instrument of evaluation of a syndrome that constitutes a psychosocial risk of the work (not a mental illness), which as one more consequence, can trigger in depressive processes, but not always. Not confusing the concepts will be essential for a correct approach.

In response to this article, Mion et al. confirm the limitations of the MBI questionnaire (we know that, especially in non-Anglo-Saxon population, poses both conceptual and methodological difficulties) but point out the importance of not confusing concepts ,  knowing that they may be related. For this, they indicate how in a study conducted by them, 67% of 241 intensivists presented high burnout (in the three dimensions of the instrument), and of them, 36% had depressive symptomatology, 6% alcohol addiction and 4% to other drugs. The presence of professional wear also correlates with sleep problems, labor disputes, autolytic ideation and traffic accidents after the night shift.

As a psychologist, I have been able to touch the depression, anxiety, discouragement, boredom and emotional pain of many health professionals. Converting that well into a tunnel in which the exit to the bottom could be seen is a long and difficult process. Maybe that is why it is not enough for me to stay on the feet with colored socks. I think it is time to reach from head to toe through the heart. It is time to establish primary prevention lines according to organizational conditions of daily work; to promote secondary prevention for adequate detection and early intervention and development of emotional, psychosocial and #humantools skills in professionals; and it is time to establish adequate channels of intervention for the care of professionals who suffer these mental health problems. Because tomorrow, we could be there any of us.